Ohkom Farms Class Registration 2010
                       (See below for   form)

Name____________________________________Phone #________________________

Address___________________________________City__________________Zip______  

E-Mail Addy if not on File_____________________________to receive updates   

Dogs Call  Name____________________________________________

Dogs Name to be put on certificate for course completions/ year end awards

_______________________________________/________________________________ 

Breed_________________________________________________

 Birthdate___________________Age_______________________Sex________________

 Spay/Neutered Yes or No, (circle) Appt date_____________________ 

 Vaccinations were given on what DATE____________________
required yearly (DHLPP, Rabies and Bordatella)

Last stool sample___________________ No dogs will be permitted if they have worms.

Please ask your vet to mark results on your record.

Flea Preventative___________________ Required in the summer months

 < Students:IF not current  ENCLOSE A COPY OF YOUR VACCINATION RECORDS>

 Fee Enclosed____________________           Fee Enclosed___________________

Class registering for______________             Class registering for______________

Start Date______________________            Start Date______________________

Make Check out and mail to: Linda  Scopa PO BOX 164 Forbes Road , PA 15633

Total enclosed Check____________________ Cash____________________________

No Refunds.  You are responsible to attend classes.    If a class of similar lessons is available you may do a make up with that class at no charge, otherwise you must schedule a private.For obedience classes, seven of the eight are required to receive a certificate.  Socialization classes all must be attended, make ups are recommended if you miss.

I have read and understand the above.  

Signature Required __________________________________________date__________

To Print only the form you need Highlight and hit Selection only on your Printer. Or email me if have trouble printing form desired. ohkom@winbeam.com

Registration Form   

 Sessions fill on a first received basis.  We will try to accommodate all the kids to the best of our availability.  

Child’s Name ____________________________________________________

Age ____________________________________________________________

Own a Dog?______________________________________________________

Afraid of Dogs?___________________________________________________

Allergies to anything?______________________________________________

Parent/ Guardian  Name_____________________________________________

Address________________________________ City__________Zip_________

E-Mail__________________________________________________________

Phone Number include Cell_________________________________________

Emergency Contact Name and Phone #________________________________  

_______________________________________________________________  

 A snack will be provided. If allergies please alert us or bring own snack. 
Please enclose $20.00 per child. T-Shirts available $10.00 each S,M,L

Parent/Guardian Signature______________________________________________

Date_______________________________________________________________